Implementation of an Evidence-Based, Electronic Clinical Algorithm to Improve Screening, Evaluation, and Referral of College Students for Depressive Symptoms and an Evaluation of Differences Based on Sexual Orientation and Gender Identity Data
Date of Award
Doctor of Nursing Practice (DNP)
Donna and Allan Lansing School of Nursing and Health Sciences
The purpose of this project was to improve the screening, evaluation, and referral of college students (LGBTQ+/Heterosexual) for depressive symptoms through the implementation of an evidence-based, electronic clinical algorithm. There is evidence in the literature indicating that there are increased mental health disparities among college students and the LGBTQ+ population. The prevalence of depressive symptoms among university students is higher than the general population, requiring university student health centers to implement enhanced screenings for depressive symptoms and identification of depression predictors. Prior to implementation of this project, a student health clinic in the Southeastern part of the United States used a paper/pencil Patient Health Questionnaire 2 (PHQ-2) scale, followed by a paper/pencil Patient Health Questionnaire 9 (PHQ-9), when appropriate, to screen for depressive symptoms. The specific aims of this project were to: (1) assess the effectiveness of an evidence-based electronic clinical algorithm to improve the evaluation of depressive symptoms among college students; (2) identify university students who self-report as Lesbian, Gay, Bisexual, Transgender, Queer/Questioning + (LGBTQ+); and (3) assess knowledge and attitudes of healthcare providers toward the LGBTQ+ community. An evidence-based electronic clinical algorithm was created to improve screening of depressive symptoms for students seeking campus health services, a self-report question related to Sexual Orientation and Gender Identity (SOGI) was added to the electronic intake form, and pre-post provider surveys of knowledge and attitudes toward the LGBTQ+ community were administered. The project was evaluated by assessing self-reported SOGI data; quantifying compliance with PHQ-2 and subsequent PHQ-9 screenings, when appropriate; and measuring knowledge and attitudes of healthcare providers pre and post-completion of a learning module. Data was collected for February through April, 2018 visits (pre-implementation) and February through April, 2019 visits (post-intervention). The pre-implementation of the electronic data form revealed that PHQ-2 screenings were offered to clinic students 44.3% of the time, with no follow-up of PHQ-9, when appropriate (0.0%); no SOGI data was requested; and no estimate was available for the prevalence of students who belonged to the LGBTQ+ community. Post implementation of the electronic data form, 93.2% of the students meeting inclusion criteria, received the PHQ-2 screening; all students scoring a positive score on the PHQ-2 were given the PHQ-9. The difference in PHQ-2 scores for heterosexual students and those self-reporting as members of the LGBTQ community, was insignificant. Students who self-reported as LGBTQ+ was 15.6%, compared to an estimated 4.5% of adults nationwide. A third assessment of provider knowledge and attitude toward the LGBTQ+ community showed no significant difference in scores pre and post completion of an LGBTQ+ teaching module.
Webb, Chris, "Implementation of an Evidence-Based, Electronic Clinical Algorithm to Improve Screening, Evaluation, and Referral of College Students for Depressive Symptoms and an Evaluation of Differences Based on Sexual Orientation and Gender Identity Data" (2019). Graduate Theses, Dissertations, and Capstones. 74.